MEDICARE: DR. AMY RYAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9601462	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205822434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY RYAN M.D.

Provider Business Mailing Address
First Line	:	1900 RANDOLPH RD
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1122
Country	:	US
Telephone Number	:	704-384-9113
Fax Number	:	704-316-0508

Provider Business Practice Location Address
First Line	:	2600 E 7TH ST
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4375
Country	:	US
Telephone Number	:	704-384-8800
Fax Number	:	704-384-8819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	10/28/2020

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